The Last Drag
Southwest Washington Health District

The Last Drag” was a cessation project that took advantage of an annual gay, lesbian, bisexual and transgender event Saturday in the Park (July 2001) to deliver cessation messages and build partnerships. The goal of the broad event is to provide “a day of laughter, music and community.” This was the first time this organization had tried to serve this population with tobacco cessation materials. Staff members collected pre-existing gay-, lesbian-, bisexual-, and transgender-specific materials and “Last Drag” quit kits were created and distributed via a booth at the event. This approach was sensitive and culturally appropriate, and helped build capacity for future interactions with this community. As follow-up to this event, similar materials were used in a local bar for the Great American Smokeout in November 2001.

The event was attended by about 2,000 people. Materials distributed included 30 “The Last Drag” Quit Kits (“Out & Free” buttons, tobacco trading cards, quit line business cards, items to keep hands busy) and 100 packets of matches with the “Out & Free” logo on the front and quit line number printed on the inside (intended for precontemplative smokers).

Anecdotal feedback indicated that people appreciated the tailored messages.

"Blow bubbles not smoke" litter bag campaign
Southwest Washington Health District

The Southwest Washington Health District developed a campaign to educate the Vancouver community about the dangers of secondhand smoke. The project incorporated logos and slogans donated by Bremerton - Kitsap County Health District staff. Southwest Washington Health District created car litter bags with the slogan “Don’t let secondhand smoke hurt your kids” and filled them with secondhand smoke information and resources. The litter bags were distributed to local car dealerships, the State Patrol, and community service agencies including the Women Infant and Children program and Parent and Child Health. Litter bags also have  been distributed at local county and health fairs, using the slogan “Blow Bubbles Not Smoke.” The project has generated community interest and support.

Retailer education blitz
American Lung Association of Washington - Yakima

Yakima youth report slightly greater ease of access to tobacco products than youth statewide, and retailer non-compliance for Yakima has been consistently higher than the state average. The American Lung Association of Washington designed and conducted a “Retailer Education Blitz” in Yakima County to inform retailers and the public about youth access laws. Information was sent to all 322 licensed tobacco retailers in the county. Adult and teen volunteers visited 72 tobacco retailers close to schools and handed out materials explaining access laws, required signs and a colorful poster stating “This store protects children’s health, we do not sell cigarettes to minors.” The American Lung Association of Washington purchased radio time to inform the public about youth access laws and encouraged citizens to speak out when they saw tobacco being sold to minors. Following the blitz, most of the visited retailers were compliance checked. Only 5 percent of retailers involved in the blitz sold to minors, in comparison to 25 percent who sold to minors during checks in 2001.

Chelan-Douglas T.A.T.U. - Building a successful program over time
Chelan-Douglas TOGETHER

The Chelan-Douglas Teens Against Tobacco Use (T.A.T.U.) group started seven years ago with one group of 20 youth members and has now grown into seven groups with about 200 members. All of the schools districts in Chelan and Douglas counties are involved in the T.A.T.U. program. To help other areas in Central Washington with new or small T.A.T.U. groups, Chelan-Douglas invited students from Grant County, Okanogan County, and the Colville Tribe to participate along with local area youth in the September 2001 training session. A total of 240 high school students and 40 trained advisors participated in this training.

Where to reach teens? At the movies!
Southwest Washington Health District

The Southwest Washington Health District ran an on-screen tobacco prevention advertising campaign in movie theaters for six weeks. The District used a slide created by the American Lung Association of Washington featuring Puyallup, Washington, native and two-time Olympic Gold medalist Megan Quann. The ad portrays Megan near a swimming pool, wearing her gold medals, and reads “My Dream, My Victory, My Future. I choose to be smoke free.” The advertising was shown continuously, seven days a week on every theater screen before every movie at all four Regal Cinema multiplex theaters in Clark County. The movie campaign was chosen as an effective and cost-efficient local advertising medium compared to billboards, radio and television. It also provided a chance to counter the presence of pro-tobacco messages displayed in movies.

Tobacco prevention street theater
Tacoma-Pierce County Health Department

The Tobacco Prevention Street Theater provides another medium to involve youth in anti-tobacco advocacy and to educate the public about the dangers of tobacco. Tacoma-Pierce County Health Department recruited a professional theater director and high-risk youth to develop and put on tobacco education presentations at local events. The performers were given tobacco training to make them stronger advocates. The theater group has completed two performances, one directed to Asian adults and another to small children. The group tailored its presentations to be culturally appropriate through discussion with community leaders and consulting with event coordinators. Currently the group is receiving an infusion of volunteers through the involvement of the local Boys and Girls Clubs. Positive feedback was received, and the group has received several requests for additional performances.

Tobacco cessation partnership
Public Health-Seattle and King County

The Community Tobacco Cessation Partnership is a collaborative effort between Public Health –Seattle and King County and the Community Health Council of Seattle and King County. The program is funded through the Public Health – Seattle and King County Tobacco Prevention Program. Program goals are to incorporate tobacco cessation activities into patient services at public health and community clinic sites; provide training and increase capacity for behavioral and pharmacological interventions; and help more high-risk tobacco users to quit. Thirty public health and community health clinics are engaged in the partnership project. These sites seek to improve their interventions with tobacco users and clients who are exposed to secondhand smoke. Health care providers from the participating sites report increasing the frequency of their tobacco use interventions with clients since the beginning of the program.

Tobacco survivor challenge
Spokane Regional Health District

The Spokane Regional Health District partnered with the Eastern Washington University Health and Wellness Prevention Services Office to develop a 5 week cessation “Survival Challenge” patterned after recently popular reality-based television shows. The purpose of the event was to raise student awareness of tobacco issues and to promote the start-up of cessation classes sponsored by college staff on the Eastern Washington University campus. Campus students selected to participate were challenged to “survive” being smoke-free. Participants attended a weekly cessation class and were given challenges centered around their individual triggers to smoke. Campus media interviewed the participants, covered their challenges, and documented their progress on the journey of cessation. Posters and buttons were created for other students to wear in support of their favorite “survivor.” The event will be repeated.

Tobacco intervention program
Northeast Tri-County Health District

The Northeast Tri Tobacco Intervention Workgroup, working with the North East Tri-County Health District, has identified a project to increase cessation resources for the low-income and rural populations of Ferry, Stevens, and Pend Oreille counties. Local doctors are invited to participate in a program to promote tobacco cessation among their clients. The Health District is reimbursing participating doctors for providing their smoking patients with separate visits to discuss tobacco cessation. A total of five visits, along with up to 90 days of nicotine replacement therapy, may be reimbursed. The Health District also is  supporting the physicians with a resource binder, quit kits, pamphlets, and cessation classes. The project outcomes are being tracked through billing and data collection forms. The project focuses on increasing tobacco cessation interventions and resources for pregnant women, youth, and adults who are ready to quit. Ninety percent of physicians have signed up to participate, and 105 patients have been served.

Jefferson County Tobacco News
Jefferson County Health and Human Services

The Jefferson County Tobacco News is a quarterly publication generated by the Jefferson County Health and Human Services Tobacco Prevention and Control Program staff. The newsletter has a distribution of 500 readers. Subscribers range from local employers to doctors to youth-serving organizations. The newsletter covers topics specifically for youth and health care providers, and highlights other issues that are in the spotlight or are of concern to the community. The newsletter has received positive anecdotal feedback from the community, created opportunities for building capacity in other organizations (such as through site-specific policy change), and provides a medium to provide tobacco education to a large and varied audience.

King County smoke-free restaurant campaign
Public Health-Seattle and King County

The past year marked the sixth year of the King County Restaurant Campaign. The campaign is designed to create more smoke-free restaurants in King County by educating restaurateurs and supporting restaurants in becoming smoke-free. The campaign is conducted on a city-by-city basis. In 2001, the cities of Algona, Auburn, Issaquah, Newcastle, Pacific, and Renton were targeted for restaurant owner and manager education. Public Health-Seattle & King County Tobacco Prevention Program staff presented each owner and manager with educational packets and discussed the benefits of becoming smoke-free. Following the campaign, there were 69 more smoke-free restaurants than in 1999. Surveys of restaurant owners and managers were conducted and determined that 77 percent of restaurants support a ban on smoking in all restaurants. Smoke-free restaurants are listed in the Guide to Smoke-Free Dining in King County. Guides were distributed to numerous citizens, community agencies, visitor bureaus, hotels, and businesses. Advertisements were placed in local newspapers promoting the guide and the local participating smoke-free restaurants. Public Health-Seattle & King County staff plan to continue supplying the public with information about smoke-free restaurants and encouraging restaurants to become smoke-free.

Adult enabling and youth access to tobacco
Public Health-Seattle and King County

Public Health-Seattle and King County awarded the Des Moines Police Department a $20,000 grant to implement a component of their tobacco prevention program. Three areas were targeted for enforcement: (1) to implement proper tobacco youth law sign and enforce laws restricting sales to minors as part of tobacco retailer compliance checks; (2) to enforce youth possession laws; and (3) to conduct reverse stings for store patrons purchasing tobacco for minors. Public Health-Seattle and King County also conducted a complementary awareness campaign to educate the community about existing youth tobacco access and possession laws. The project has proven to be successful in increasing the number of youth contacts, increasing compliance among retailers, improving retailer education, and decreasing the number of sources youth have for acquiring tobacco.

Tobacco education with incarcerated youth
Educational Service District 114

Educational Service District 114 is responsible for delivering the education system for juvenile detention centers in Port Orchard and Port Angeles. Educational Service District staff had observed that a high proportion of the incarcerated youth considered themselves to be smokers before their detention. In detention facilities, juveniles are not allowed to smoke and get to experience the “cold turkey” method of cessation. While they are in a forced state of cessation, Educational Service District 114 is taking advantage of the opportunity to educate them about the dangers of tobacco, how the tobacco industry targets them, and how they can stay smoke-free and be involved in tobacco advocacy in their community. Future directions include increasing evaluation efforts to measure the prevalence of pre-incarceration tobacco use and changes in intention to remain tobacco-free after release.

"No smokes on me!"
Puget Sound Educational Service District 121, Puyallup School District

The Puyallup School District, in conjunction with The Tobacco Advisory Committee sponsored a multimedia art project called “NO SMOKES ON ME!” School-based survey data showed that ten percent more Puyallup School District students reported never trying smoking in 2000 than in 1998. The intention of the project was to develop student-designed and delivered anti-tobacco messages to reinforce the non-smoking and non-tobacco using norm among all Puyallup students. This project provided staff training and classroom art materials to support the development of the artwork and media messages. Representative artwork from among all Puyallup youth will be chosen for reproduction and mass media use throughout the district. Community partners are supporting the project and will display the created art. This project builds upon existing partnerships between the Educational Service District, school district, and community, and attempts to empower youth by creating media messages that are not being addressed by the statewide media campaign.

Youth tobacco cessation collaboration
Educational Service District 112, Southwest Washington Health District

Educational Service District 112 and Southwest Washington Health District have developed an innovative partnership to implement substance abuse prevention and intervention services for high school students in Clark and Skamania counties. The collaboration between the health district, with its mission to serve teens in the community, and the Educational Service District, with its mission to serve school districts, provided an opportunity for cooperation inside the school buildings. Identified alignment of these similar organizational missions led to pooling of resources and structures so that the Educational Service District, could provide services to high school (10th-12th graders) youth who are excluded from the school-based tobacco prevention program target population. The team hired a Substance Abuse Intervention Specialist and developed and piloted a youth cessation model strategy, known as “the Continuum of Change.” The pilot project included tobacco policy enhancements and referrals to cessation/intervention classes for youth who violate policies. Strategies for intervening included use of Teen Tobacco Users (TEG), Helping Teens Stop Using Tobacco (TAP), and a Media Literacy program.

School District 81 (Spokane) tobacco policies and procedures workgroup
Educational Service District 101

Educational Service District 101, together with district school administrators, school resources officers, students, and community members worked together to create tobacco policies and procedures for School District 81. The planning committee reviewed model policies and procedures, and created flow charts, referral forms, a new policy, and procedures. The policy covered use, possession, and sale or giving away of tobacco on all school property, at school sponsored events, in school buses and on property neighboring school campuses. The school board passed the policy, and school staff was trained in the policy. Educational Service District 101 set up diversion classes for policy offenders. The referral form that is issued for offenses looks similar to a regular law enforcement ticket. The school resource officers worked with the police department who helped to enforce the policy by issuing real tickets if students failed to attend diversion or cessation classes as directed. Educational Service District 101 also has  trained at least one representative from each middle school and high school in the End Nicotine Dependence youth quit program. Since the initiation of the policy, the number of students attending diversion classes has tripled.

Youth-centered tobacco prevention program
Edmonds School District

Edmonds School District nurses applied for and received a grant from the American Lung Association to implement a youth-centered tobacco prevention program. The program provided all-school tobacco awareness, and uses the Teens Against Tobacco Use (T.A.T.U.) peer education model. Nurses, teachers, other school staff, community volunteers, and parents were trained to be adult advisors and education assistants. Youth in 7th through 9th grades from four high schools were trained to be peer mentors and presented tobacco education to 4th through 6th grade students from two middle schools.

Mr. Butts
Jamestown S'Klallam Tribe, Clallam County Department of Health and Human Services

Clallam County Health and Human Services partnered with Jamestown S’Klallam Tribe to deliver tobacco prevention messages to young children. Teens received training about tobacco issues and designed presentations to deliver to younger youth. As part of the Great American Smokeout, tribal teens visited seven different daycares and children’s programs in Clallam County. Each teen-created presentation included demonstrations, pictures, games, and free giveaways. Letters were sent home to parents with information about secondhand smoke and local and statewide cessation resources. More presentations were made on Kick Butts Day in April. This partnership was mutually beneficial: staff working with tobacco prevention in Clallam County Health and Human Services did not have access to a teen group, and the Jamestown S’Klallam Tribe was in need of resources and opportunities for their teen group.

UNTOLD regional youth summit
North West Educational Service District 189, Skagit Affiliated Health Services, Whatcom County Health and Human Services, Snohomish Health District, Upper Skagit Indian Tribe, Island County Health Department, Swinomish Tribal Community, San Juan County Health Department, Lummi Indian Business Council, American Lung Association, American Cancer Society.

The UNTOLD Regional Youth Summit is a one-day event to train teens to use media literacy skills to analyze tobacco messages, and to empower them to create anti-tobacco media campaigns in their local schools and communities. The event was organized by more than 30 youth representatives from five counties and three tribes. Experienced trainers in media literacy taught participants to decode media messages and their intent. Teens were trained to create anti-tobacco radio, television and print advertisements. Small group activities during the day motivated youth to join in local tobacco prevention coalition efforts and have fun fighting “Big Tobacco.” In the process of joining forces to combine resources and skills, the groups developed a strong partnership. Future goals include a follow-up activity to determine how the youth have put their training to work in their communities.

High school Native American clubs 
Colville Confederated Tribes

The Colville Confederated Tribe Tobacco Program staff worked through Culture Clubs in area schools to recruit tribal teens for youth tobacco prevention activities. Sixty-six youth have been recruited from four schools. All of the youth received T.A.T.U. training and some have received other youth training including “Teens, Tobacco and Media,” the American Cancer Society's Speak Out! Workshops and Camp, and have attended events like the “It’s the Truth. It’s an Outrage” youth summit. Involvement of tribal youth as leaders is a vehicle for creating broader changes in tribal community acceptance of tobacco use among other youth and their families.

Systems change in tribal clinic
Puyallup Tribe

The Puyallup Tribal Health Authority has developed a clinic systems change strategy to treat nicotine dependence. In the first year of implementation, Puyallup Tribal Health Authority’s office-based delivery system will be improved to effectively identify, track, and conduct intervention and follow-up with tobacco using patients. All patients over the age of six will be screened for tobacco use and exposure to secondhand smoke. The system uses the Agency for Health Care Policy and Research's Brief Intervention Model for treating nicotine dependence, also known as the “5-A Model” (Ask, Assess, Advise, Assist, Arrange). Puyallup Tribal Health Authority plans to track each patient’s progress through chart documentation. The goal of the project is to achieve a 10 percent reduction in adult tobacco use among tribal clinic clients by 2006. Taking a thoughtful approach, and engaging staff at all levels of the organization, is key to the long-term success of this project.

Puyallup tribal outreach-Canoe Families and other events
Puyallup Tribes

The Puyallup Tribal Health Authority organizes a variety of tobacco prevention outreach activities for the Native American community in the Tacoma area. These activities include a Tobacco Free-Pow Wow Fun Run, the Great Native American Smoke Out, and educational events at the tribal school. The Great Native American Smoke Out reaches hundreds of people each year with education. In 2001, employees wore t-shirts to celebrate its fifth year and to greet the 300 plus patients visiting the clinic with a smoke-free message. The Tobacco Free - Pow Wow Fun Run attracted more than 120 people in 2001. The Health Authority also supports the activities of the Puyallup Tribal Canoe Family. The Canoe Family is tobacco-free and each summer they take their tobacco-free message from village to village on the annual canoe journey. Incorporating culture into the prevention activities is effective in changing norms around tobacco use.